Neurosurgery stripped Nalwanga of princess-like behavior

Black elbow sleeve dress, with floral print on the front. Black low heel pumps. A short spring twist hairstyle.

 When I think of a neurosurgeon, my mind’s eye brings up a somber being in medical scrubs or, at the very least, a lab coat. True, every other medical person in the Neurosurgery Ward, in Mulago Hospital’s Department of Surgery, is in a white lab coat. But, not Dr Juliet Nalwanga Ssekabunga.

“I do not put on scrubs when I am out of theatre. When I finished my residency, I spend most of the time supervising ward rounds and I usually do that at 5am every morning,” she says.

At 38, Dr Nalwanga is Uganda’s first female neurosurgeon. As she moves between two offices, looking for space for us to sit, she tells me that Uganda’s second female neurosurgeon completed her exams on Wednesday last week.

The nurses’ station finally empties and our interview commences. “I have gone without sleep for days! We have junior doctors in residency who attend to patients. But, I also love seeing patients. That is why I am here (at the ward) by 5am. I love to find out everything about a patient and his or her name, on my own before the doctors brief me,” she says.

I wanted to be rich

As a neurosurgeon, Dr Nalwanga also teaches medical students. A few minutes before this interview, she was grading two students. Surprisingly, as a child, she never dreamt of being a doctor, even though her father, the late Prof Ssekabunga, was the first pediatric surgeon in East Africa.

“My mom saw me as the naughtiest of 10 children. She kept saying, ‘Omwana wange kasita atuuka e Makerere, kimala.’ Literally translated as: As long as my child goes to Makerere University, that is enough for me. 

Her father, on the other hand, did not have time for her and the siblings while growing up. ‘’When I was a child, I wanted to work in a bank and become a rich woman. I was not prepared for a medical career, even when I would watch my father go to hospital every day,” she says.

By the time she was born, her father was at the tail end of his career, going into retirement. So, paying school fees throughout her primary at St Agnes Primary School Nagalama, was a hurdle. 

“Occasionally, I would go to school without school fees or report a month after the other students have already reported. Of course, my mother did everything to make ends meet. Sometimes, uncles chipped in. I was one of those children who were always topped the class, so one of the school administrators told mom to always bring me to school,” she says.

Things changed in her Primary Seven, when her aunt, Dr Jane Bbosa, offered to educate her. In Senior One, at Ndejje Senior Secondary School, Nalwanga fell in love with biology and chemistry.

“I hated physics! (She laughs). But, I also liked history and geography. I think I loved history because it was easy to cram. In Senior Three, I chose sciences. My aunt assured me that whatever my choice was, she was willing to support me,” she says.

Loss of parents

Three days before her Senior Four final examinations, Dr Nalwanga’s mother passed away.  “After the burial, I went back to school, but I was not in the rightful mental state. We had grown up on our mother’s side, so, when she died, I knew that whoever was helping us, including my aunt, would stop. I sat my exams and fortunately, when the results were announced, I was the best performing girl in my year,” she says.

Her aunt continued paying her school fees even at A-Level. Her big sisters, Alice and Irene Ssekabunga also supported her. She joined Uganda Martyrs Secondary School Namugongo. Unfortunately, a few months after joining Senior Five, her father also passed on.

“The competition in Namugongo was stiff. On some occasions, I would be the last in class. Oh my God… Dr John Chrysostom Muyingo! They would read a list and say, ‘These are the academic dwarfs. Sometimes, I would be on that list. I used to ask myself, ‘How can I change this?’ But, my mom (aunt) always boosted my confidence.” 

Almost losing the dream

Dr Nalwanga scored 15 points in the Uganda Advanced Certificate Examination (UACE). She did not make it to the admission list at Makerere University. She was, however, admitted to Mbarara University of Science and Technology (MUST).

“I spent weeks crying! I cried! (She laughs). I had lived all my life in Kampala. I had never been to Mbarara. I was a lastborn. How could I leave my aunt behind? On the day she drove me to Mbarara and left me there, I cried,” Nalwanga recalls.

Her aunt advised her to introduce herself to Prof Fredrick Kayanja, who at the time, was MUST’s vice chancellor.  She met him towards the end of the orientation week.

“He was so happy to see me. He said I was the daughter of one of his very good friends. Life became comfortable after meeting him and in 2008, I completed my studies and went for internship in Lira and Mulago Hospitals.”

After her internship, Nalwanga got pregnant. She realised that she needed rest, so she went to work at the Western Campus of Kampala International University, in Bushenyi. Many of the doctors she met advised her to specialise and become a surgeon, something she first refused to consider.

Married to the job

To be at the Neurosurgery Ward in Mulago Hospital by 5am, Dr Nalwanga wakes up at 4am from Monday to Friday. On weekends, she comes in at 7am. When I inquire whether she gets time to pack in some house chores, she laughs.

“I live with my son, my 24-year-old niece, and another 24-year-old woman, who I look after. She also has three children who live with us. So, the house is well taken care of. Besides, I am a single mother and I think I am at a comfortable place in my life,” she says.

“Lonely as a mother? No. The house is too full to get time to be lonely. I am dealing with children of all ages, and I usually get home late (about 8pm). I had to choose between staying as a housewife and surgeon, and pursuing my neurosurgical career. I chose neurosurgery. My son’s father probably thought … well, I am one of those people who love to take it (her career) to the end.”

Sacrifices

 Her former partner is also in the medical field, and it got to a point where someone had to stay at home and take care of the child.

“He was in and out of the country. I wanted to pursue my career, and he wanted to do his public health stuff. And then, of course, he wanted another child. So, we sort of just agreed to move our separate ways,” she says.

Besides her aunt, Dr Bbosa, Dr Nalwanga was also raised by another aunt, Margaret Kyobe. She says all of these have been supporting of her decision to follow her dream.

Path to neurosurgery

Dr Nalwanga loved internal medicine, and by 2008, she hoped she would specialise in it. But, what she saw on the wards, during her internship prompted her to shelf her dream.

“You walk into an emergency room and you have lost five or six patients a day. It is traumatising. Sometimes, you have no idea why the patient has died. Other times, I would enter the ward and the nurse would say, ‘doctor, today we wheeled eight to the mortuary.’ I could not handle that situation,”  says Dr Nalwanga.

Towards the end of her internship, she met Prof Stephen Kijjambu, who at the time was head of Mulago Hospital’s department of surgery. Nalwanga’s father had taught him surgery.

“He told me I had to become a surgeon. Although I laughed about it, it would later usher me into a new dawn. I wanted to be a cardiac surgeon. Prof Kijjambu introduced me to the department, where I met neurosurgeons. Dr John Baptiste Mukasa and Dr Hussein Ssenyonjo became my mentors everything,” she adds.

Motherhood and career

In January 2010, MUST advertised for an assistant lecturer position in surgery. Dr Nalwanga applied, although she had never done surgery. She got the job, and six months later, she started her residency in general surgery.

“I was breastfeeding my son. One day I was on call for far too long – 36 hours. When I went back home, he refused to breastfeed. Sometimes, I would go 48 hours without seeing my baby,” says Nalwanga.

In 2014, she graduated as a general surgeon and in September, that year, she joined Mulago Hospital’s College of Surgeons of East, Central and Southern Africa, to study neurosurgery.

Not a princess anymore

“At Mulago, every princess-like behaviour I had was stripped away. I would cry often. It was so emotionally disturbing. Neurosurgery is not sentimental. There is a patient here, and as you are putting on scrubs to work on him, he dies. The patient next in line is also dying and you must attend to him. And the one next in line, had already died. You are thinking, ‘Oh my God! I have lost the patient!’ As you are still thinking, they wheel in the next one, and you must start attend to them.”

She remembers that the year before, Prof Michael Haglund, the coordinator of the Duke Global Neurosurgery and Neurology Programme, had told her he hoped that when she came for neurosurgery, she would not leave.

Any regrets?

“The first six months were hell. People expected me to give up, but I wanted to prove them wrong. In general surgery, I would leave my son for long hours. But now, with neurosurgery, I only saw him briefly,” she adds.

Dr Nalwanga sighs as she remembers those days. “I let down my motherly role. That was the time I made the decision to leave my son’s father. There was this whole emotional thing and he (her son) was feeling it too. It is like in the brief time my son and I met, we were both trying to communicate (our emotional pain to each other) but we were on different paths,” she says. 

A year later, she gained confidence. She commends the neurosurgeons she found in the department, such as Dr Michael Muhumuza, Dr Joel Kiryabwire, Dr Mukasa, and Dr Ssenyonjo, who played a fatherly role in her career.

“I would run to Dr Muhumuza with my tantrums and emotions and he would look at me, and say, calmly, ‘Julie, in that situation you could have done this.’ These were men who expected me to be as good as they are and they were not ready to wait for me. I had to catch up quickly,” says Dr Nalwanga.  

Life as a neurosurgeon

Even in the best medical settings, Dr Nalwanga says the brain is very complicated and there are things about its working that cannot be explained as yet.

“Even if you come to the hospital early, the brain does not wait. I have seen people with whom we have done our best, but even then … you just lose them. On the other hand, so many patients have gotten well to the point that when they come back to the clinic (for review) and you cannot believe that was the patient you saw with the swelling on the brain. You feel glad you did something for them,” she says, poignantly.

Like any other doctor, the temptation to seek for greener pastures is always there. When she went to study pediatric neurosurgery at the University of Toronto in Canada for 18 months, she was tempted.

“As a resident, you are given monthly welfare upkeep for yourself and for your dependents, until you get a job. So, you can imagine. But, my son and niece are here. Then, there was the uncertainty brought by Covid-19. Besides, there is so much work to be done here – we are a baby specialty and there is so much backlog,” she says.

Do it against all odds

She advises girls who want to specialise in her field – or any other field – to know their priorities.

“It is not bad to want to be a mother but if you want to take your career to the next level, purpose to do it against all odds because the world is not favourable. We have aunts and uncles insisting that we must get married, have children … but if you want stand out and make a difference, there are decisions you must make. That is what worked for me,” she says.

As we conclude, I ask if she would have considered motherhood now, if she had not given birth before she became a busy surgeon. “Oh yes. As much as I am busy, I have some free time now. Some days are crazy, but there is time (to be a mother),” says Dr Nalwanga.

Tough career 

‘‘At Mulago, every princess-like behaviour I had was stripped away. I used to cry often. It was emotionally disturbing. Neurosurgery is not sentimental. There is a patient here, and as you are putting on scrubs to work on him, he dies. The patient next in line is also dying and you must attend to him. And the one next in line, had already died. You are thinking, ‘Oh my God! I have lost the patient!’ As you are still thinking, they wheel in the next one, and you must start attend to them.”

Even in the best medical settings, Dr Nalwanga says the brain is very complicated and there are things about its working that cannot be explained as yet.